Matta Abhishek, Koppala Jahnavi, Gossman William
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA.
BMJ Case Rep. 2014 Apr 9;2014:bcr2014204198. doi: 10.1136/bcr-2014-204198.
A 26-year-old Hispanic man with no significant medical history presented to our emergency room with gradual onset weakness of his lower extremities. He was haemodynamically stable and examination revealed loss of motor function in his lower limbs up to the level of hips. Laboratory data revealed hypokalaemia. The patient was started on potassium supplementation and he recovered his muscle strength. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis (TPP). Further investigations revealed a low thyroid-stimulating hormone and high free thyroxine levels. Radio iodine 123 scan revealed an enhanced homogeneous uptake in the thyroid suggesting Graves' disease. Thyroid stimulating antibodies were also found to be elevated. The patient was started on methimazole and propranolol and he never had another attack of TPP even at 1 year follow-up.
一名26岁无重大病史的西班牙裔男性因下肢逐渐出现无力症状前来我院急诊室就诊。他血流动力学稳定，检查发现其下肢运动功能丧失，直至臀部水平。实验室检查数据显示低钾血症。患者开始补钾治疗后，肌肉力量得以恢复。鉴别诊断包括家族性低钾性周期性麻痹和甲状腺毒症性周期性麻痹（TPP）。进一步检查发现促甲状腺激素水平低，游离甲状腺素水平高。放射性碘123扫描显示甲状腺摄取均匀增强，提示格雷夫斯病。还发现甲状腺刺激抗体升高。患者开始服用甲巯咪唑和普萘洛尔，即使在1年的随访中也未再发生TPP发作。
